If Republicans aren't confident enough to let the CBO score their healthcare plan, they shouldn't try to pass it

By Abbe R. Gluck and Sherry Glied

Mar 10, 2017 | 4:00 AM

Speaker of the House Republican Paul Ryan gives a presentation on the Republican plan to repeal the Affordable Care Act and replace it with the American Health Care Act, in Washington on March 9. (Michael Reynolds / EPA)

Early reviews of the proposed legislation reveal that it would harm low-income populations — and the states left holding the bag for those populations — as well as likely further destabilize insurance markets. It would radically change the healthcare system. But neither Congress nor the American public knows the exact implications.

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That's where the CBO should come in. It's required by law to estimate the costs and consequences for the federal budget of every bill (other than an appropriations bill) approved by a full committee of either the House or the Senate.

These professional, nonpartisan estimates provide critical information to legislators. The Republicans leading the repeal effort, however, have already moved the replacement bill through the two House committees that oversee the ACA, without letting the CBO do its job.

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The Republican Congress is racing through its repeal at breakneck pace, without deliberation, study or accountability.

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Democrats and Republicans alike complain if the CBO scores a bill in a way that hurts their aims. But no major piece of modern legislation has been passed without the CBO's analysis. The CBO was founded in 1975 precisely to address the problem of Congress passing legislation with an incomplete, partisan assessment of its likely effects. Congress created the new budget agency, under its own control, in the wake of concerns about the objectivity and transparency of the Nixon administration's cost estimates. The CBO's importance has grown through the years, under control of both parties, and its current director is a Republican.

The CBO's role in health reform has been particularly important. Its estimates disappointed proponents of President Clinton's health plan and contributed to its poor reception in Congress. Conversely, the CBO's estimates of the 2003 Medicare Modernization Act, which were even more favorable than those provided by the Bush administration, facilitated passage of that legislation.

Republicans often claim that the ACA was passed under cover of night. But during debate over the ACA, the CBO released 35 separate reports estimating the costs of various legislative proposals, as well as additional analyses responding to specific congressional concerns. Committee members — and the public — had the benefit of these calculations before they were expected to vote. Now the Republican Congress is racing through its repeal at breakneck pace, without deliberation, study or accountability. Indeed, the bill went through the two committees on Thursday, without a single change.

The White House press secretary, Sean Spicer, has already tried to discredit the CBO — presumably laying the groundwork to ignore a score the president won't like. But subsequent analyses have shown that the CBO's forecasts of the likely effects of the ACA, as well as its forecasts of earlier expansion efforts, were admirably accurate, and generally more accurate than anyone else's, including those of most private sector forecasters.

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And the CBO's work goes beyond assessing how legislation might affect the federal budget. In the run-up to the ACA's passage, the CBO also assessed how various proposals would change the nature and cost of coverage in private markets. The repeal legislation would likewise change these markets. The CBO could tell us how.

Republican sidelining of the CBO is especially galling since the party likes to sell itself as the one that cares about dollars, cents and deficits. In fact, Republicans passed a rules package last month that required the CBO to more carefully document how legislation affects the deficit. At the same time, they specifically exempted ACA repeal from that requirement. They want us to have faith in their repeal without even having the CBO complete its standard analysis.

Republicans claim they want to repeal the ACA because it has been an economic "disaster." All right, then — on what measure would their bill count as an improvement? The number of people covered? No one has suggested that the Republican proposal would preserve coverage for all of the 20 million Americans who got insurance under the ACA, never mind the millions more who could still benefit from it. If the advantage is an economic one, the CBO should be allowed to do the books.

Abbe R. Gluck is professor of law and faculty director of the Solomon Center for Health Law and Policy at Yale Law School. Sherry Glied is dean of New York University's Wagner School of Public Service and former assistant secretary of planning and evaluation at the US Department of Health and Human Services.